The difficult airway and transoral robotic surgery

Abstract

A systematic approach to airway management for transoral robotic surgery (TORS) will translate to a high-reliability system capable of handling anticipated and unexpected difficult airway situations. Intubation and glottic exposure for surgery need to be considered as distinct but critical components. Preoperative team briefings can contribute to effective planning and preparedness. Management options for TORS difficult airway should include formal consideration of awake tracheostomy and surgical microdirect laryngoscopy to facilitate intubation. Preinduction airway assessment by flexible fiberoptic exam or videolaryngoscopy can be helpful to inform shared decision making. Ideally in all facilities that perform TORS, a difficult airway ID and structured, multidisciplinary airway rapid response system is in place. A high risk extubation identification and formal extubation and/or reintubation planning process may further promote safety for TORS patients who remained intubated postoperatively. A team and instrument focused protocol for the management of emergent bring backs for bleeding or other complications is critical.